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Healthy andalucia

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Healthy ANDALUSIA 2008

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ANDALUSIA Andalusia, one of the largest regions in Europe, is located in the south of Spain, with its coastline bathed by the waters of the Mediterranean and the Atlantic. With a size of 87,597 square kilometers, and a population of 8.059.461 inhabitants, Andalusia is the most populated autonomous community in Spain. 16,22% of the population is younger than 15 years of age and 14,63% is older than 65. Main figures 1.500 Primary care centres (387 Main PHC, 1.113 Local PHC) 44 Public hospitals (5 level I, 9 level II, 6 level III, 14 level IV, 10 proximity H)1 8 Transfusion centers 88.310 Healthcare professionals 9.518,91 M € Health budget 1 Level I (≥1.000 beds), Level II (500-1.000 beds), Level III (250-500 beds), Level IV (≤250 beds); Proximity Hospitals in remote areas. Life expectancy at birth (2006): Men 76,4 years, Women 82,5 years ≥1

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HEALtH PoLIcy GoALS IMprove the publIc healthcare SySteM, > based on the values of universality, access to good quality care, equity and solidarity. ModernIze health organIzatIonS, > making them more flexible and citizen – centred, ensuring good governance and transparency. IncreaSe the value of the publIc ServIce SySteM. >≥2

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BASIcINSPIrING PrINcIPLES Quality as the driving force:> • A strongly coordinated and efficient public system in continuous growth. • Quality-driven for response time, accessibility, continuity, familiarity, comfort, human touch, high technology, safety and efficient performance. Accesibility and Transparency:> • More and better-informed citizens with increased freedom to make decisions, take greater responsibility over their own health, and gain equal opportunities through transparent and accurate information. Social Control:> • Active social participation on an individual and collective basis. • An organization that listens to its citizens as allows them to participate in decisions making. Professional Participation:> • obtaining, recognizing and stimulating commitment by professionals is the key to success and to secure their essential participation. ≥3

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cItIzENS at the center of the Health System citizens are the center of the Andalusian Public Health System. they show great sympathy for the health care received, the professionals and the organization, which is measured with an annual user - satisfaction survey. Different measures have been designed to empower citizens and patients with > new rights in health care: • SeConD MeDICAL oPInIon: in case of severe diseases, citizens have the right to demand a qualified second opinion, which is provided by experts within 30 days since the application. • LIVIng wILLS: Andalusian citizens have the right to record their wills, on a specific registry, about the limits to health care when being in situations of not possible communication. Physicians have the obligation to consult this registry before applying special treatment to patients not able to communicate. • DenTAL CAre for CHILDren AnD PregnAnT woMen: free from 6 to 15 years old, and women during pregnancy. • Surgery wAITIng LISTS: the Andalusian government has been the first in our area to introduce the legal right to a guaranteed maximum waiting period for surgery (180 days). recently it has been updated, reducing the waiting time for the most common interventions to 120 days. the information is available at the Department of Health web page. • ouTPATIenT SPeCIALIzeD CAre AnD DIAgnoSTIC ProCeDureS wAITIng LISTS: legal rights has been extended to guarantee a maximum delay for outpatient specialized care (60 days for first referral from primary health physician) and the most common diagnostic procedures (30 days). • PreIMPLAnTATIonAL geneTIC DIAgnoSIS (PgD): the Public Health care System has included PGD to avoid the transmission of genetic disorders. this service is offered in a public hospital. • geneTIC CounSeLIng: among a number of measured listed in the Andalusian Genetic Plan, new integrated genetic units, providing genetic testing and counseling, are being implemented.≥4

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• DenTAL CAre for HAnDICAPPeD: the coverage by the public dental care services has been extended to handicapped people. • CHILDren neeDS In HeALTH CAre fACILITIeS AnD SerVICeS: health care facilities and services are being adapted to the special needs and requirements of children and newborns, such as being accompanied by a close relative (mother or father) during their stay in hospitals. • eLDerLy AnnuAL CHeCk-uP: people over 65 years old are being contacted, in order to assess their health status, and are being offered with the health services they may need. • PoDIATrIC/CHIroPoDIC CAre for PeoPLe wITH DIAbeTeS, under the Diabetes care Plan. family support measures> • chronic homecare plans and community nursing activities • Extension of rehabilitation units throughout the territory, including mobile units for home rehabilitation care. • Improvement of mental health care services. The citizens’ voice> • Area Health committees by province. • Annual survey on user satisfaction. • Virtual office –InterS@S-, where the user can choose a primary health care physician or center, update his/her personal data, make requests,… • call center: single telephone number, where demands and suggestions can be made, as well as asking for medical appointments or basic medical advice. • citizens’ expectations Bank: web site to foster citizens’ participation as well as associations and other health system stakeholders. ≥5

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Integrated and coMprehenSIve planS have been designed to compile the> different measures and actions adopted in a wide range of fields, in respond to major health problems. Some highlights of the different Plans are detailed below. • Diabetes Care Plan: information for the public and patients, improve health care services, including early detection for major complications (retinopathy), prevention and health education, citizens participation, training and research. • OnCOlOgy Plan: health promotion activities, oncology day care in all hospitals, palliative care, new radiotherapy units, improve social and emotional support. research and training. • CarDiOvasCular Disease Care Plan: secondary prevention and rehabilitation programme, pediatric surgery, adult congenital cardiovascular disease unit, training and research. • Mental HealtH Plan: mental welfare promotion, information for the public, increase accessibility, community mental health units, day care units, training and research. • tObaCCO Plan: media campaigns, web portal and telephone service supporting tobacco cessation, training programmes for health professionals, education and work, special smoking cessation units at primary and specialized care, special situations (mental health patients, prisons), training and research. Legal actions (suit) against tobacco companies. • DePenDent PeOPle strategy: designed to support people with special needs. coordinated with the Social Welfare Department. • alZHeiMer’s Disease Plan: in collaboration with associations of relatives and caregivers, includes different programmes designed for the needs of these patients and their families, such as healthcare, family support, stimulation and reeducation, training, volunteering and research. • infant Obesity Plan: includes more than a hundred preventive, healthcare, training and research measures. School dining rooms support services. • aCCiDents HealtHCare Plan: different measures in order to reduce accidents, and to minimize their consequences. ≥7

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• Patient safety strategy: designed to improve the management, training and information systems. Includes an observatory on Patient Safety and a registry on adverse events. • genetiCs Plan: establishes a network for providing genetic services for the population, identifying and optimizing the available resources, and opening new lines for the development for research and health care. • rare Diseases Plan: early identification of rare diseases, structured health care network within the health system, coordination with different units involved. • Palliative Care Plan: designed to attend patients at end stages of their diseases, under a common protocol, and to support their families and close carers. • Pain Care Plan: standardizes care and pain relief throughout the Andalusian health system. • assisteD rePrODuCtiOn PrOgraMMe: extension of public health care services of assisted reproduction techniques in the public hospitals and centers for those who need them, including women without male partners.≥8

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QUALIty-DrIVEN cArE In 2005, the Department of Health launched its Second Quality Plan for the Andalusian Public Health System, continuation of the first comprehensive Quality and Efficiency Plan of 2002. this Second Healthcare Quality Plan echoes the vocational search for a different, more modern organization, placed at the service of the Andalusian public, that strives to provide a public service committed to guaranteeing the best possible care, imbuing the Andalusian Public Health System of an entrepreneurial attitude with a view to taking on new challenges to ensure survival of a public healthcare system that is caring, fair and sustainable. This second Healthcare Quality Plan has a process-based structure. five major> strategic processes have been pinpointed: • To ASSuMe CITIzenS’ neeDS AnD exPeCTATIonS: defines the relationship between citizens and the APHS, and points to the public’s central role in the system, as well as the duty to establish a set of guidelines to safeguard that principle. the plan suggests developing new rights and fresh mechanisms to step up citizen’s participation and decision-making powers, as well as their clinical safety, fostering projects that will enhance interaction between citizens and the system in a more individualized, transparent and interactive manner. • To guArAnTee HeALTH CAre SerVICeS QuALITy MAnAgeMenT: attempts to build up the innovations in service management that have unfolded in Andalusia over the last few years. Indeed, clinical management, process-based management and skills management, continue to be vital tools that need to be enhanced by implementing actions that will lead to their definitive consolidation in the system. It incorporates an Andalusian Accreditation Model, reinforcing the Andalusian Healthcare Quality Agency. • To guArAnTee QuALITy In PubLIC HeALTH PoLICIeS: intends to bring about a system of public guarantees on the basis of three processes; foster policies targeting health promotion and disease prevention, boosting quality in public health surveillance policies and promote quality policies in health protection. ≥9

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• knowLeDge MAnAgeMenT: the health system is a knowledge factory, an intelligence system, implementing a health information strategy, promoting and consolidating research excellence in Andalusia. • InnoVATIon AnD MoDernIzATIon of THe SySTeM: innovation is a cross-cutting process influencing the entire array of actions to be unfurled by the Second Healthcare Quality Plan. two major strategic strands are established: horizontal innovation policies and information and technology management. It is a proposal to address the Healthcare System challenges in an efficient > manner. The challenges can be summarized as follows: • Improve all aspects concerning relations with the public. • create an organization in line with the healthcare targets. • continue process-based work, so that all healthcare activities revolve around the patient. • Make further progress in skills management for professionals. • Strive towards the integration of healthcare in a knowledge-based society. • Enhance the system’s overall transparency – financial, operational, quality, etc –in the eyes o the public, bearing in mind at all times that we are managing vast and increasing, albeit limited resources. • Boost organizational research and Innovation. • Provide added value to the Second Modernization Plan for Andalusia by contributing to well-being and creativity while fostering a more modern public administration, which is closer to community grassroots.≥ 10

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rESEArcH andInnovation one of the strategic objectives of the Ministry of Health of the Andalusian regional Government is to foster the generation of knowledge within the Andalusian Public Health System, in particular biomedical research. therefore, the Strategic Plan for research, Development and Innovation for the period 2006-2010 has been launched by the regional Ministry of Health, which is aligned with and coordinated by existing programmes at a European, national and regional level, including all parties actively involved in the innovation system. the Plan’s structure reflects the articulation of biomedical r+D+i in its triple perspective: of resources, production and the transfer of research results. Legal framework for stem cell research: Law for cellular reprogramming for therapeutic purposes. Support to clinical trials, pre-implantation genetic diagnosis in Andalusian public hospitals. research centers and institutions: combining basic research (at universities> and the Spanish research Council) and applied research (health professionals at the Andalusian Public Health System) with the biotechnology sector. • new THeMATIC reSeArCH CenTerS: linked to the main research areas in the region, molecular biology and regenerative medicine, genetics and nanomedicine. 1. regenerative Medicine (cABIMEr - Andalusian Molecular Biology and regenerative Medicine center) is a groundbreaking multidisciplinary biomedical research center in Andalusia, drawing together basic and applied research with the aim of transforming the results of the scientific work carried out there into direct improvements to citizens’ health and quality of life, Seville. 2. Genomics and oncology (GENyo), Granada. * 3. Nanomedicine (BioNAnd), Malaga.* 4. Advanced technologies in Medical traning (cMAt), Granada. * construction in process ≥ 11

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e-HEALtH Strategy the Andalusian Public Healthcare System has adopted corporate information systems as a strategy, given the increasing mobility of the citizens and the participation of many professionals in attending to the processes, forming complex multidisciplinary teams. All this, linked to the integrated concept of health and the leading role of the citizen in democratic societies, leads to the concept of the Single Health record and the use of unified procedures. DIrAyA> computer system for information and care management support. Diraya integrates all the information of each user, into a Single Health record, so that it is available where and when it is needed for his/her care. It also facilitates accessibility to all the services and provisions of the health system, and ensures that all the relevant information is structured. Diraya, meaning “knowledge” in Arabic, is the outcome of the organization’s shared knowledge. Diraya consists of a set of related modules that share information • basiC COMPOnents: - User Data Base (UDB): supply every citizen with a Single Andalusian Health record Number (NUHSA), to which all his/her information is linked. 7.96 millions registered users (98.8% of the population). - centralized operator Access Module (coAM). - Structure Module, including departments and functional units as well as physical locations. • single HealtH reCOrD, in 682 primary health care centers, covering 7,373,409 inhabitants (93.7% total population); 6.6 millions with relevant clinical data (90%). In specialized care: 71.1% emergency episodes, 14.4% outpatient visits. • PresCriPtiOn XXi: electronic prescription: in 653 primary health care centers, covering 7,272,090 inhabitants (92.4% total population), 3,496 pharmacies (97.8%), and 70 millions prescriptions (38%). ≥ 13

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• aPPOintMent: manages primary care, outpatient specialized consultations and diagnostic procedures agendas. 73.439.928 appointments in Diraya during 2007. • InterS@S: Public Health System Virtual office, allows users to change doctor, to see and update their personal data, or request a second medical opinion. HeALTH reSPonDS (SALuD reSPonDe) > Information and Service center, available 24 hours a day all days of the year. Multi-channel access to the Public Health System of Andalusia, designed to satisfy the information and service needs of citizens and health professionals, improving the capacity of response of the health system and making it faster. It services include medical appointments for primary care, information of the Public Health System of Andalusia, information≥ 14

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about the health smart card, dental health programme, free choice of hospial, second medical opinion, community link nursing, living will statement, health campaigns, follow- up on fragile patients after hospital discharge or heat waves, and medical advice. It also offers SMS information services (health campaigns, appointments reminder, health prevention measures,...), information on tobacco (quit-line), citizens’ service line for health technology and devices. InforMArSe.eS SALuD> Health information service using multichannel platforms such as internet, mobile phones, tV and other media. A new model of communication in health, based on innovation, assuring information accuracy and quality, and accessible trough different channels and platforms. oPInAr.eS SALuDAbLe> New tool for the reception and knowledge of citizens’ expectations. People can leave opinions, suggestions and needs. It helps the Health System to seek what the citizenship expect from the services provided, and the initiatives launched. InnoVATIVe PrACTICe bAnk> Strategy for the identification, sharing and acknowledgement of innovative professional practices. It includes a network of agents among the health professionals in the organization. It promotes the development of innovation forums ,ideas contests and best practices identification and diffusion. obSerVATory of InnoVATIVe PrACTICeS In CHronIC DISeASe MAnAgeMenT> created as a network focused on the identification, process, synthesis and dissemination of innovative practices in Spain and the world. Accessible at a web page, it supports knowledge management, as well as collaboration between excellence focuses. Developed in open source technology. ≥ 15